Company :Highmark Inc.
Job Description :
The SVP of Markets is responsible primarily for leading the delivery system-related performance and strategies in Highmark’s NY, Central and Eastern PA, and DE markets. This includes coordinating all market-performance related levers in those geographies as well as developing the strategy, programs, and overall relationships with our Transformation Provider partners in those markets. The SVP will work closely with all Highmark segment (e.g., Government, commercial) leaders to understand the performance and network needs in each geographic market and then coordinate the strategy development and building the networks to deliver that performance across key metrics including quality, risk revenue, affordability, access, customer and clinician experience and equity. The SVP of Markets will also play a key role, working as a partner to Highmark’s Chief Medical and Clinical Transformation Officer (CM&CTO), in working with the C-suite teams at each of the major partners in Highmark’s footprint areas on transformational strategies. As such the SVP of Markets will be Highmark’s primary face to the provider community. The SVP of Markets will also work in a highly matrixed role with the CM&CTO, SVP of Provider Performance and Transformation, the SVP of Provider Contracting, and the Commercial Segment Presidents in each market to deliver on their objectives. The SVP therefore will need to have experience working in leadership roles inside delivery system entities as well as the ability to influence and work highly collaboratively with both internal and external executives.
- Set and lead the delivery of the key financial and operating targets in each market, with a dedicated commitment to optimize revenues, maintain cost effective operations, and provide continuous performance improvement. Accountable for meeting targets in areas of Risk Revenue, Quality/stars, affordability, reimbursement/contracting trend, network alignment.
- Develop the “Living Health” (Highmark’s long-term strategy for improving health outcomes) network and partnership strategies for each market, recommending which providers to develop relationships with and how to align products and networks to evolving market competitive dynamics.
- Oversee the full relationships with all parts of the delivery system, including guiding contract negotiations and handling operational issues. Responsible for ensuring that provider relationship goals are set and met every year.
- Actively leading the transformational strategies with the Strategic Partners in each market, pulling on the others in the organization for delivery. Active leadership includes regular governance and strategic design of the transformation plan as well as managing strategic/anchor provider CEO relationships as the most senior Highmark executive and representing Highmark to appropriate market-based constituencies.
- Alongside clinical partners, ensure that physician and system leadership is engaged to create a culture of alignment and further develop and drive an effective clinical integration strategy, which positions Highmark Health and the provider partner systems as the preeminent brand in the market. Work with physician aggregators to ensure appropriate structures and effective physician management of populations resultant in economic returns associated with that management and lower cost of care for members.
- Alongside the segment partners, ensure coordination of all market-performance related levers in responsible geographies as well as the development of the strategy, programs, and overall relationships with our Transformation Provider partners in those markets.
- Attract, retain, and develop top talent, focusing on succession planning and the cultivation of a best-in-class senior leadership team. Cultivate an organizational culture that drives workforce engagement focused on innovation, learning and continuous improvement.
- Along with Data and Analytics, identify opportunities for improvement in KPIs not meeting expectations as well as trends emerging in the market requiring actions. Trend may include increases in utilization, total care costs, potential new asset development, or other provider site of care changes. Meet regularly with management to report on outcomes and actions being taken to address variations from expectation.
- Along with Data and Analytics, work in partnership with segment leads and with health plan to identify mutual synergies to address profitability resulting from cost reduction strategies in PMPM including its drivers in disease-based management, care management, utilization management, and risk coding opportunities as well as pharma strategies.
- Accountable for growth related to various levers, including care alignment, attributed membership and share of wallet across the markets.
- Represent Highmark Health in the industry for our market approach with provider, producers, customers, regulators, and other community stakeholders.
- Other duties as assigned.
- 15+ years in the Healthcare industry, with some portion of that as part of a delivery system entity
- 15+ years in a management or leadership role
- 5 years in strategic planning
- Strong analytic background
- Clinical operations experience.
- Understanding & managing provider performance, specifically in hospitals, physician practices or health systems.
- Business process redesign, change management or program development.
- Experience in complex program management, MSO capability development or operation improvement.
- Experience working within a matrixed organization.
- Capable of managing provider CEO relationships as most senior Highmark executive.
- Broad application of principles, theories and concepts in strategic thinking.
- Breadth of knowledge related to Healthcare industry trends.
- Demonstrated executive presence with outstanding communication skills (verbal, written, and presentation) as well as excellent negotiation, networking, and interpersonal operating and finance skills.
- Ability to work effectively across many matrixed functions and with the senior executive leadership team.
- Strong analytical and interpersonal skills.
- Presentation skills and a proven ability to communicate detailed information to healthcare executives, provider leaders and physicians.
- Strong project management skills including the ability to manage multiple projects and meet concurrent deadlines.
- Bachelor's degree in business or health
- Master's degree in business or health
LICENSES or CERTIFICATIONS
Language (Other than English):
0% - 25%
Financial : How much business will the leader oversee in the new role, in dollars?
Strategy : What role will this person play in creating the business strategy? How many year(s) forward will this role have accountability for creating?
Decision Making Authority: What level of oversight will you have regarding strategy (i.e., what types of decisions might you approve)?
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Office- or Remote-based
Teaches / trains others
Travel from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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